System and method for enhanced data analysis with specialized video enabled software tools for medical environments

ABSTRACT

Medical software tools platforms utilize a surgical display to provide access to specific medical software tools, such as medically-oriented applications or widgets, that can assist surgeons or surgical team in performing various procedures. In particular, an endoscopic camera may register the momentary rise in the optical signature reflected from a tissue surface and in turn transmit it to a medical image processing system which can also receive patient heart rate data and display relevant anomalies. Changes in various spectral components and the speed at which they change in relation to a source of stimulus (heartbeat, breathing, light source modulation, etc.) may indicate the arrival of blood, contrast agents or oxygen absorption. Combinations of these may indicate various states of differing disease or margins of tumors, and so forth. Also, changes in temperatures, physical dimensions, pressures, photoacoustic pressures and the rate of change may indicate tissue anomalies in comparison to historic values.

PRIORITY CLAIMS

This application claims the benefit and is a continuation of U.S. patentapplication Ser. No. 15/958,983, filed Apr. 20, 2018, which is acontinuation of U.S. patent application Ser. No. 15/789,948, filed Oct.20, 2017, which is a continuation in part, claims the benefit of U.S.patent application Ser. No. 15/652,031, filed Jul. 17, 2017, which is acontinuation in part of U.S. patent application Ser. No. 15/456,458,filed Mar. 10, 2017, which is a continuation in part of U.S. patentapplication Ser. No. 15/377,817, filed Dec. 13, 2016, which is acontinuation of U.S. patent application Ser. No. 14/107,329, filed Dec.16, 2013, and issued as U.S. Pat. No. 9,526,586 on Dec. 27, 2016, whichclaims the benefit of U.S. Provisional Patent Application Ser. No.61/865,037, filed Aug. 12, 2013. This application also claims thebenefit of and is a continuation in part of U.S. patent application Ser.No. 15/170,575, filed Jun. 1, 2016, which claims the benefit of Ser. No.13/430,489, filed Mar. 26, 2012, which is a continuation-in-part of U.S.patent application Ser. No. 12/776,048, filed May 7, 2010, which claimsthe benefit of U.S. Provisional Patent Application Ser. Nos. 61/182,624,filed May 29, 2009, and 61/234,577, filed Aug. 17, 2009. Each of theforegoing applications is hereby incorporated by reference.

TECHNICAL FIELD

The technology disclosed herein relates to medical software tools and,in particular, some embodiments relate to systems and methods for asoftware tools platform in a medical environment, such as a surgicalenvironment, incorporating enhanced data analysis.

BACKGROUND OF THE INVENTION

During minimally invasive surgeries, medical imaging devices may beintroduced into a subject's body to illuminate and image body cavities,organs or other tissue. Advantages of using internal medical imagingdevices include the ability to avoid large incisions and the ability toimage biological tissue. Many imaging devices also include one or morelenses that focus images onto an eyepiece and/or imaging lens. Still orvideo cameras may be used to capture image data using a medical imagingdevice.

Medical imaging devices can enable surgeries to be performed in a mannerthat is less intrusive and often safer for patients. While this bringsmany benefits to patients, it presents a number of challenges for thesurgeon who must work within a very confined surgical compartment. Inparticular, surgeons must deal with poor visibility, limited lighting,and a narrow viewing angle. Because of their size, conventional medicalimaging devices tend to have limited imaging resolution, often fail toprovide more than one perspective of biological tissue, and due tovisible lighting constraints, often fail to show differences inbiological tissue.

Minimally invasive surgeries increasingly occur in operating roomsequipped with advanced audio-visual technology. At one end of thespectrum are integrated operating rooms, that combine high resolutionvideo displays, touch screen control, access to digital informationthrough the hospital network, and data archiving capability into aninterconnected purpose-built system. In addition to facilitatingsurgical procedures and improving efficiency, integrated operating roomscan also connect the surgeon in the sterile field with people andinformation outside the operating room. For example, an integratedoperating room can enable: live consultation with pathology and ICU;real-time collaboration with surgeons across the globe; live feeds toconference rooms and auditoriums for training and grand rounds; and dataexchange with an electronic medical record system, radiological picturearchiving and communication system (PACS), or network-enabled devices inother operating and treatment rooms.

In many surgical procedures it is critical to monitor the status orhealth of tissue or organs surrounding any given surgical procedure.Perfusion, which measures the rate tissue or an organ absorbs fluid, canbe used to distinguish normal tissue from diseased tissue. One techniqueused is to inject contrast fluid into the blood stream and use imagingmodalities to measure the rate the blood spreads through the tissue ororgan. Another technique is to use an endoscopic optical sensor tomeasure both the amount and speed of change in one or more of thespectral components reflected from the surface of tissue or an organ inresponse to a heartbeat, a patient's breath, or an external stimulus tomeasure and characterize the state of body tissue and organs.

SUMMARY OF THE INVENTION

Various embodiments of the disclosed technology provide a medicalsoftware tools platform that utilizes a surgical display to provideaccess to medical software tools, such as medically-orientedapplications or widgets, that can assist those in the operating room,such as a surgeon and their surgical team, with a surgery. For variousembodiments, the medical. software tools platform and its associatedmedical software tools are presented on a surgical display (e.g., beingutilized in an operating room) over an image stream provided by asurgical camera (e.g., in use in the operating room) or other medicaldevice that generates image streams. An image stream can include videoor a series of static images (e.g., medical ultrasound device). Variousmedical software tools can provide features and functions that canfacilitate integration of equipment in an operating room or add medicalcontext awareness to anatomic structures presented in the image streamfrom the surgical camera.

Medical video display panels and multiscreen displays are commonlyemployed in such contexts as hospital operating theaters or any facilitywhere surgical operations are carried out in a sterile environment. Theyare used to display visual information from data streams such assurgical imagery from an endoscope, patient vital signs, patient medicalrecords, clinical imaging data (patient CT scans, MRIs, etc.), outputsfrom other operating room equipment, and operating room environmentalstatus. Surgical displays and multi-screen video displays provide asurgeon and their surgical team with visual information that can beautomatically updated, or can be used to enable collaboration amongviewers. Where a surgical display or multiscreen video display is usedfor group collaboration, there is generally a requirement that the grouphas the ability to update and reconfigure the visual informationdisplayed, which is usually facilitated through a video switch.Traditional video switches are controlled through a switch box, akeyboard, or a local connection (via an RS-232 port or Ethernet port)and have only a single point for control access. In some contexts,visual data streams to a single large panel video display or amultiscreen display configuration are provided by two or more computersystems, each being controlled by a computer operator (i.e., user) usingsuch input/output (IO) devices as keyboards, mice, and as video monitor.At times, it is convenient for the computer operator to share the IOdevices between the computers by means of a device that switches the IOdevices between the multiple computers. These switches, often referredto as a Keyboard-Video-Mouse (KVM) switch, are commanded by the computeroperator (e.g., commanded by a special keyboard sequence or a button onthe KVM switch) to switch a common keyboard, mouse, or video monitorbetween controlling the computer systems.

According to some embodiments, a system comprises an image streaminterface module configured to receive an image stream from a surgicalcamera, a user interface overlay module configured to provide a userinterface overlay adapted for presentation over the image stream, and amedical software tools module configured to provide a medical softwaretool through the user interface overlay. The medical software tool maybe configured to perform an operation with respect to the image streamand provide an output adapted to be presented over the image stream. Theuser interface overlay can include a graphical user interface (GUI) thatpermits visibility of at least some of the image stream underlying theuser interface overlay. The user interface overlay module is furtherconfigured to present the output over the image stream. Depending on theembodiment, the surgical camera may be an endoscope or a laparoscope.Additionally, the image stream interface module may receive the imagestream from the surgical camera through an image stream processingsystem.

Throughout this description, a user interface will be understood to beaccessible to any user involved in a medical procedure, such as asurgery. It will also be understood that a user can include anyindividual involved in a given medical procedure, such as a nurse or asurgeon.

In some embodiments, the system comprises a medical device communicationmodule configured to exchange data between a medical device and themedical software tool. Through the medical device interface module, someembodiments can enable a medical software tool to present informationfrom disparate medical devices, or facilitate sharing of informationbetween medical devices. In some embodiments, the system comprises animage stream processing system interface module configured to exchangedata between an image stream processing system and the medical softwaretool, the medical software tool being configured to modify a setting ofthe image stream processing system. The setting of the image streamprocessing system can include enabling or disabling application of animage stream processing algorithm to the image stream. Through the imagestream processing system interface module, the medical software tool cancontrol how the image stream processing system receives and processesimage streams eventually presented on the surgical display.

Depending on the embodiment, the operation performed by the medicalsoftware tool may comprise a visual tag over the image stream inassociation with an anatomical structure or tissue presented in theimage stream, and the output may comprise the visual tag. The operationperformed by the medical software tool may comprise measuring ananatomical structure or tissue (e.g., width, height, length, or volume)presented in the image stream, and the output may comprise a resultingmeasurement. Where the image stream comprises two-dimensional content,the operation may comprise converting at least some of thetwo-dimensional content into three-dimensional content, and the outputmay comprise the three-dimensional content (e.g., stereoscopicthree-dimensional content). The operation performed by the medicalsoftware tool may comprise associating content in the image stream witha timer, and the output may comprise a visual representation of thetimer. The operation performed by the medical software tool may compriseidentifying content (e.g., anatomic structure) in the image streamsimilar to reference content (e.g., reference anatomic structure), andthe output may comprise a visual indication of the identified content.The operation performed by the medical software tool may comprise aidingthe surgeon in identifying anomalous tissue or defining the margins of atumor or diseased area to be excised by analyzing subtle color changesin the tissue called micro-blushes, caused by the blood rushing in andout, to create an optical signature.

A system or method in accordance with the present invention mayselectively and dynamically route one or more image input streamsthrough one or more dynamically selectable and iterative algorithmprocessing elements (or modules) before the resulting processed streamsare routed to one or more selectable outputs. For some embodiments,dynamic selection with respect to inputs means that one or more inputscan be selected or unselected in real time for routing to one or moreimage processing elements. For additional embodiments, dynamic anditerative selection with respect to processing elements means that aselected image stream can be routed to one or more image processingelements simultaneously and in real time. The routing may be based uponcriteria relating to the image stream's source, the image stream'scontent, or on the processing results of a preceding image processingelement. The output of an image processing element may be directed backto the system or method for routing to a subsequent image processingelement, or to one or more image outputs that supply an image stream toan output device (e.g., display, image recorder, or other imageprocessor, or transmission device).

An exemplary system for collaboratively switching an image stream inputto an image stream output, comprising: an image stream input interface;an image stream output interface; a first image processing module,wherein the first image processing module is configured to accept animage stream from the image stream input interface or another imageprocessing module, apply an image processing function to the imagestream, and output a processed image stream; and a switching matrix,wherein the switching matrix is in communication with the image streaminput interface, the image stream output interface, and the first imageprocessing module such that the switching matrix can selectively map(i.e., route) the image stream input interface to the image streamoutput interface or to the first image processing module, and theswitching matrix can selectively map the processed image stream from thefirst image processing module to the image stream output interface or toa second image processing module. An image stream includes both a steadyflow of image frames (i.e., video) and image stills captured at a setinterval (e.g., once every hour). Additionally, for some embodiments thesystem comprises a plurality of image processing modules, a plurality ofimage stream input interfaces, or a plurality of image stream outputinterfaces. Furthermore, in further embodiments, the system may beintegrated into a display having a display output, wherein the imagestream output interface is in communication with the display output.

In some embodiments, the image processing module is a field programmablegate array (FPGA) to which algorithms, such as image processingfunctions, can be programmed and changed if desired. Additionally, withthe use of multiple images processing functions, algorithms, such asimage processing functions, can be executed in a predetermined oradaptive sequence. Exemplary algorithms include convolutions, real-timeadaptive histograms, and algorithms capable of processing multipleframes simultaneously (e.g., image subtraction function).

One of ordinary skill in the art would understand that, depending on theembodiment, either the image stream input interface, the image streamoutput interface, or both may utilize unidirectional communication orbidirectional communication with input devices and output devices. Forexample, a system may be configured to receive control information froma controller interface device via an image stream output interface, orto send control information to an image source via an image stream inputinterface. In another example, the control information is received bythe system through the Display Data Channel (DDC). Depending on theembodiment, the system may be configured to send control information toa device external to the system, through the image stream inputinterface.

In some embodiments, the switching matrix may selectively map an imagestream input interface or a processed image stream in real-time. Infurther embodiments, the switching matrix may selectively map the imagestream input interface to more than one image processing module or tomore than one image stream output interface simultaneously.Additionally, in some embodiments, the switching matrix may selectivelymap the processed image stream to more than one image processing moduleor to more than one image stream output interface simultaneously. Inother embodiments, the switching matrix may selectively map an imagestream input interface or the processed image stream based on acriterion. For example, the switching matrix may selectively map animage stream input interface or a processed image stream based on itssource or content. In another example, the switching matrix mayselectively map a processed image stream based on the results of apreceding image processing module. Depending on the embodiment, theimage processing module may have the capability of processing aplurality of image streams in parallel. The image stream interface forsome embodiments may be configured to receive the image stream from animage stream capture device, an image stream playback device, a computersystem, a sensor device or a medical device (e.g., endoscope). The imagestream output interface for some embodiments may be configured to outputto a display (e.g., liquid crystal display monitor), a computer system,or recording device (e.g., digital video recorder). Further, in someembodiments, the system may be configured to output an image streamthrough a virtual display.

In numerous embodiments, the system further comprises a data inputinterface, wherein the switching matrix is further in communication withthe data input interface such that the switching matrix can furtherselectively map the data input interface to the image stream outputinterface or to the first image processing module. For some suchembodiments, the image stream input interface may comprise the datainput interface.

With respect to protocols and interface types, in various embodiments,the image stream input interface or image stream output interface has aDigital Video Interface (DVI) connector, High-definition MultimediaInterface (HDMI) connector, a Bayonet Neill-Concelman (BNC) connector, afiber optic connector, a DisplayPort connector, a Universal Serial Bus(USB) connector, or a Fire wire (IEEE1394) connector. In regard toformats, the image stream input interface is configured to convert fromor the image stream output interface is configured to: a Digital VideoInterface (DVI) standard (e.g., DVI-D digital mode, DVI-A analog mode),a High-definition Multimedia Interface (HDMI) compatible standard, aRed-Green-Blue (RGB) Analog standard, a Red-Green-Blue (RGB) Digitalstandard, a DisplayPort standard, a National Television System Committee(NTSC) standard, a Phase Alternate Line (PAL) standard, or a SerialDigital Interface (SDI) standard.

The image processing function in some embodiments may comprise an imagestream mix function, an image stream scale function, an image streamblend function, an image stream encoding algorithm, or an image streamenhancement function. For those embodiments having an image streamenhancement function, the image stream enhancement function may comprisea de-haze function, a de-blur function, a shadow function, a dawn-duskfunction, a fusion function, a (motion) stabilization function, athermal turbulence function, an equalization function, an edge detectionfunction, a rain and fog function, or a light optimizing function.Further, in some embodiments, the system can eliminate or reduce framelatency by configuring an image processing module to apply processingresults of a given frame to a subsequent frame.

In additional embodiments, where the image stream is provided by anendoscope, the image processing function can enhance the image streamfor detecting texture differences in living tissue, detecting a polyp,detecting anomalous tissue, detecting blood circulation, or identifyingreference locations for subsequent registration of images from anothermodality. In further embodiments, a light optimizing function may adjusta color channel for the image stream in order to detect polyps. Forexample, the system may apply image processing functions in real time toimage feeds from an endoscope in order to detect differences in livingtissue, detect anomalous tissue, determine boundaries where tissuetexture changes (for tissue volume and size information), and identifyreference locations for subsequent registration of images from othermodalities.

With respect to the last objective for image processing function, imageregistration is the process of determining the alignment between twoimages that have overlapping regions, where the images may be acquiredat different times and/or by different sensors. The difficulty inaligning such images is further increased during multi-modal imageregistration, where the images are acquired using different imagingtechniques (e.g., two images that share similar content may have verydifferent intensity mappings).

For some embodiments, dynamic selection with respect to inputs meansthat one or more inputs can be selected or unselected in real time forrouting to one or more image processing elements. For additionalembodiments, dynamic and iterative selection with respect to processingelements means that a selected image stream can be routed to one or moreimage processing elements simultaneously and in real time. The routingmay be based upon criteria relating to the image stream's source, theimage stream's content, or on the processing results of a precedingimage processing element. The output of an image processing element maybe directed back to the system or method for routing to a subsequentimage processing element, or to one or more image outputs that supply animage stream to an output device (e.g., display, image recorder, orother image processor, or transmission device).

The image stream interface for some embodiments may be configured toreceive the image stream from an image stream capture device, an imagestream playback device, a computer system, a sensor device (e.g., amedical device like an endoscope). The image stream output interface forsome embodiments may be configured to output to a display (e.g., liquidcrystal display monitor), a computer system, or recording device (e.g.,digital video recorder). Further, in some embodiments, the system may beconfigured to output an image stream through a virtual display. One areawhere the alignment of images of different modalities (i.e., multi-modalimage registration) is important is in the field of medical imaging.Different medical imaging techniques, such as x-rays, computedtomography (CT), magnetic resonance imaging (MRI), and positron emissiontomography (PET), reveal different types of information about the bodythat can be used in the diagnosis of a disease. For example, considerthe comparison of a slice from a cranial T1-weighted MRI scan and itscorresponding CT scan. The bone structure of the head, for example, willbe clearly visible in the CT scan, and indicated by the bright areas inthe image. The bone structure has a higher radio density than thesurrounding tissue. This is not the case for an MRI scan where, unlikethe CT scan, tissue differences can be clearly distinguished.Accordingly, the alignment of images of different modalities (e.g.,image from a MRI scan and a CT scan) would allow for a better overallpicture of a patient's condition.

Accordingly, in some embodiments, algorithms such as edge detection, sumof squared differences (SSD) and Fast Fourier Transform (FFT) areprogrammed into the image processing module such that multi-modalregistration of images, such as from multiple medical imagingmodalities, can be achieved. Sum of squared differences (SSD) is acommon metric used for judging image similarity by a weighted sum ofsquared differences (SSD) cost function. The evaluation of the SSD costfunction can be performed efficiently using the Fast Fourier Transform(FFT) to determine the optimal translation between two images based onpixel intensities.

In some embodiments, the image stream enhancement function performed bythe image processing module comprises an auto-focus function capable ofadjusting focus of an image stream capture device that is coupled to theimage stream input interface and producing the image stream. Forexample, the auto-focus function may comprise the operations of:performing an edge detection algorithm on the image stream, therebyproducing the processed image stream; and generating focus instructionsfor the image stream capture device based on the processed image stream.In further such embodiments, the operations of the auto-focus functionare repeated iteratively until the image stream capture device isin-focus. In other embodiments, the edge enhancement algorithm utilizesa Laplacian convolution.

In certain embodiments, the system further comprises a control interfacethrough which a user may operate or configure the system, among otherthings (e.g., check status of the system). For some such embodiments,the control interface may comprise a display touch panel having agraphical user interface, a keyboard, or a mouse, which are all examplesof human machine interfaces (HMIs). For particular embodiments where theimage stream output interface is outputting to a computer system, thecontrol interface may be directly connected to the system and notconnected to the computer system.

In some embodiments, the system can detect what type of image streaminput interface, image stream output interface, or image processingmodule is present in the system, and configure the system according tothe type. Further, in some embodiments, the system can detect what typeof image stream input interface, image stream output interface, or imageprocessing module is present in the system, and configure the controlinterface according to the type. For example, the system may detect thetypes of circuit cards present in each card slot of its chassis,self-configure the mix of image input cards, image processing cards, andimage output cards detected, and present to the user a visualrepresentation interface according to the mix for the purpose ofproviding image routing choices. It should be noted that in someembodiments the control interface comprises virtual buttons.

Various embodiments may enable multiple users/viewers to collaborativelycontrol a system or method for switching multiple input image streams tomultiple output devices, while providing optional image processingfunctions on the image streams. The collaborative control may, in realtime, create, remove, reposition, or resize one or more virtual displaysbeing outputted to an output device. Virtual displays may permit acollaborative user/viewer to split-screen, implement apicture-in-picture (PIP) window, and determine image stream source for avirtual display (e.g., to display new information). The collaborativecontrol may allow multiple points of access, whereby multiplecollaborative users/viewers can simultaneously access the collaborativecontrol and dynamically update or reconfigure the virtual displays orthe image stream being displayed in a virtual display.

The collaborative control interface may comprise a web-based interfacethat enables operation of the system, configuration of the system, or astatus check of the system, and wherein the web-based interface isaccessible by the users by way of a network connection with the system(e.g., Ethernet, Wi-Fi, or serial connection). The collaborative controlinterface may be further configured to receive commands from the users,store the commands into a queue, and perform the commands on the systemin accordance with the queue. The commands may relate to operating thesystem, configuring the system, or checking a status of the system. Thesystem may detect what type of image stream input interface, imagestream output interface, or image processing module is present in thesystem, and configure the collaborative control interface according tothe type.

Where at least one of the users is an administrative user and at leastone of the users is a non-administrative user, a command from theadministrative user through the collaborative control interface may beperformed before a command from the non-administrative user. Where atleast one of the users is an administrative user and at least one of theusers is a non-administrative user, the administrative user may operatethe system, configure the system, or check a status of the systemthrough the collaborative control interface at the exclusion of thenon-administrative user.

An exemplary method for collaboratively switching an image stream inputto an image stream output, comprising: receiving a first command from afirst user by way of a collaborative control interface accessible by twoor more users simultaneously, wherein the first command relates toconfiguring a switching matrix in communication with a plurality ofimage stream input interfaces and an image stream output interface, andwherein the switching matrix is configured to selectively map an imagestream input interface of the plurality of image stream input interfacesto the image stream output interface; and receiving a second commandfrom a second user by way of the collaborative control interface,wherein the second command relates to configuring the switching matrix.The method may then store the first command and the second command(e.g., based on time of receipt, command type, user or user type issuingthe command), in a queue; and perform the first command and the secondcommand in accordance with the queue, thereby configuring the switchingmatrix in accordance with the first command and the second command.Subsequently, the method may receive an original image stream from theimage stream input interface of the plurality of image stream inputinterfaces; and using the switching matrix (e.g., as configured by thefirst and second commands) to selectively map the original image streamto the image stream output interface.

In various embodiments, storing the first command and the second commandin the queue may be based on an order in which the first command and thesecond command are received, based on a first priority of the firstcommand and a second priority of the second command, or based on a firstuser type of the first user and a second user type of the second user.

Where the switching matrix outputs the original image stream to avirtual display, in a mapped image stream, being outputted to the imagestream output interface, the first command or the second command mayinclude creating the virtual display, closing the virtual display,resizing the virtual display, repositioning the virtual display withinthe mapped image stream being outputted to the image stream outputinterface, or moving the virtual display to another mapped image streambeing outputted to another image stream output interface.

An exemplary system for switching control between a plurality ofcomputer systems, comprising a plurality of image stream inputinterfaces, wherein a first image stream input interface of theplurality of image stream input interfaces is configured to couple witha first computer system of the plurality of computer systems, andwherein a second image stream input interface of the plurality of imagestream input interfaces is configured to couple with a second computersystem of the plurality of computer systems. The system may furthercomprise a plurality of computer input device interfaces (e.g.,Universal Serial Bus [USB], PS/2, AT connector, Bluetooth, Infrared[IF], or FireWire), wherein a first computer input device interface ofthe general plurality of computer input device interfaces is configuredto couple with the first computer system, and wherein a second computerinput device interface of the plurality of general computer input deviceinterfaces is configured to couple with the second computer system.

The system may additionally comprise: a central computer input deviceinterface (e.g., Universal Serial Bus [USB], PS/2, AT connector,Bluetooth, Infrared [IF], or FireWire); a central image stream outputinterface; and a switching matrix in communication with the plurality ofimage stream input interfaces, the plurality of general computer inputdevice interfaces, the central computer input device interface, and thecentral image stream output interface. The switching matrix may beconfigured to map the first image stream input interface to a firstvirtual display being outputted through the central image stream outputinterface and map the second image stream input interface to a secondvirtual display being outputted through the central image stream outputinterface. The switching matrix may be further configured to selectivelymap the central computer input device interface to the first computerinput interface or the second computer input interface based on alocation of an input cursor with respect to a first display region beingoutputted through the central image stream output interface or a seconddisplay region being outputted through the central image stream outputinterface. The first virtual display may be in the first display region,the second virtual display may be the second display region, and theinput cursor may be controlled by way of the central computer inputdevice interface.

Selectively mapping the central computer input device interface to thefirst computer input interface or the second computer input interfacemay be further based on whether the input cursor is entering or exitingthe first display region or the second display region. In someembodiments, the first virtual display may coincide with the firstdisplay region, and the second virtual display may coincide with thesecond display region. Depending on the embodiment, the input cursor maybe a mouse being controlled by a mouse coupled to the central computerinput device interface or a keyboard cursor being controlled by akeyboard coupled to the central computer input device interface.

An exemplary method for switching control between a plurality ofcomputer systems, comprising: receiving a first image stream at a firstimage stream input interface configured to couple with a first computersystem of the plurality of computer systems; and receiving a secondimage stream at a second image stream input interface configured tocouple with a second computer system of the plurality of computersystems. The method may further comprise: using a switching matrix tomap the first image stream from the first image stream input interfaceto a first virtual display being outputted through a central imagestream output interface; and using the switching matrix to map thesecond image stream from the second image stream input interface to asecond virtual display being outputted through the central image streamoutput interface. The method may additionally comprise receiving inputinformation from a central computer input device interface; and usingthe switching matrix to selectively map the control information from thecentral computer input device interface to a first computer input deviceinterface or a second computer input device interface based on alocation of an input cursor with respect to a first display region or asecond display region. The first display region may be outputted throughthe central image stream output interface, and the second display regionmay be outputted through the central image stream output interface. Thefirst computer input device interface may be configured to couple withthe first computer system, and the second computer input deviceinterface may be configured to couple with the second computer system.The first virtual display may be in the first display region, the secondvirtual display may be the second display region, and the input cursormay be controlled by way of the central computer input device interface.

Other embodiments provide for a computer readable storage medium havinginstructions embedded thereon to cause a processor to perform operationssimilar to those described above with respect to the various systems andmethods in accordance with the present invention.

Other features and aspects of the disclosed technology will becomeapparent from the following detailed description, taken in conjunctionwith the accompanying drawings, which illustrate, by way of example, thefeatures in accordance with embodiments of the disclosed technology. Thesummary is not intended to limit the scope of any inventions describedherein, which are defined solely by the claims attached hereto.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram illustrating an example of the overallprocessing system that may be used in implementing various features ofembodiments of the disclosed technology.

FIG. 2 is a block diagram illustrating an example of the imageprocessing system that may be used in implementing various features ofembodiments of the disclosed technology.

FIG. 3 is a block diagram illustrating an example medical software toolsplatform in accordance with some embodiments of the technology describedherein.

FIG. 4 is a block diagram illustrating the measurement, opticalsignature module, timer and checklist modules within the medicalsoftware tools platform.

FIG. 5 is a block diagram illustrating the optical signature measurementmodule within the medical software tools platform.

FIG. 6 is a rendering of the Surgeon's Desktop software toolset

FIG. 7 is a rendering of the intensity height map tissue analysis tool

FIG. 8 is a rendering of the color map tool.

FIG. 9 is a rendering of the various color display tables for the colormap tool.

FIG. 10 is a rendering of the margin guide outline tool.

FIG. 11 is a rendering of the algorithm developer tool.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 is a block diagram illustrating an example of the overallprocessing system that may be used in implementing various features ofembodiments of the disclosed technology. In accordance with thepreferred embodiment of the present invention, the processing system 100consists of processor elements such as: a central processing unit (CPU)102; a graphics processing unit (GPU) 104; and a field programmable gatearray (FPGA) 106. The processing system 100 may be used to retrieve andprocess raw data derived from a surgical camera 110 or a data storagedevice, such as a medical archive 108. The surgical camera 110 ormedical archive 108 transmits a data stream to the processing system100, whereby that data is processed by the CPU 102. The FPGA 106,connected to the CPU 102 and the GPU 104, simultaneously processes thereceived data by using a series of programmed system algorithms 118,thus functioning as an image clarifier within the processing system 100.The GPU 104 communicates with the user interface 112 to display thereceived data from the medical archive 108. The GPU 104 enables the userinterface to then communicate the data to connected input devices 114and output devices 116. The user interface 112 can communicate tomultiple input 114 and output devices 116 simultaneously. An inputdevice 114 can include, for example, a keyboard, touchscreen or voiceactivated device. An output device 116 can include, for example, a videodisplay, a digital video recorder (DVR) or universal serial bus (USB).

FIG. 2 is a block diagram illustrating an example of the imageprocessing system that may be used in implementing various features ofembodiments of the disclosed technology. In accordance with thepreferred embodiment of the present invention, the image processingsystem 200 consists of three components that process image data receivedfrom a sensor 202 in order to send that data to a display or videorouter 210. The three components of the image processing system 200 are:camera head video pre-processing 204; real time video enhancement 206;and the video display transport 208 function. Image data is collected bya sensor imaging device 202, and is then transmitted to the camera headvideo pre-processing component 204 within the image processing system200. This data may be, for example, a raw video image that ispre-processed using various image processing algorithms. Imagepre-processing may also include software modules for image registrationand segmentation to optimize the video data and communicate via thesystem bus 212 with the internal system processors 214: the CPU; GPU;and FPGA.

The pre-processed image data is transmitted to the real-time videoenhancement 206 component, whereby the image data is enhanced to improveclarity or highlight certain details. Once the image data resolution hasbeen enhanced, the video display transport 208 component completes imagepost-processing, formatting from the initial sensor resolution to theeventual display resolution, for example, enhancing the video data to1080p HD or 4K display resolution or using software modules such asvideo cross conversion, scaling and adding graphic overlays. Theprocessed image data is then transmitted from the image processingsystem 200 to the display or video router 210. The video displaytransport also saves the processed image data to the processing systemmemory 216 that can consist of internal and external memory storage.

FIG. 3 is a block diagram illustrating an example medical software toolsplatform system in accordance with some embodiments of the technologydescribed herein. The medical software tools platform provides access tomedically-oriented applications (apps) or widgets that can assistmembers of the surgical team during an operation. For example, during asurgery it is common to clamp a blood vessel for a short period, but theclamp must be removed before damage occurs to the tissue that depends onthe vessel's blood flow for necessary oxygenation. A timer app could beused to apprise the surgeon of the elapsed time and also the remainingtime that it is safe for the clamp to be in place. Additionally, thetimer app could monitor the area around the clamped blood vessel forchanges in color which would indicate declining levels of tissueoxygenation and generate an alert when the color indicates tissue oxygensaturation may be declining below safe levels. In a second example, agrid overlay app could overlay gridlines over a portion of the displayedvideo stream. The gridlines provide a means of marking the location ofbiopsy samples. Additionally, the gridlines allow the surgeon toaccurately measure anatomical structures that are displayed. As a thirdexample, an annotation tool app allows the surgeon to superimposecircles or squares or to draw around features or areas of interestdisplayed on the screen and associate digital tags or notes for futurereference. In a final example, when surgeons excise diseased tissue itis common to also remove a narrow margin around it. The challenge, ofcourse, is to clearly visualize and identify the demarcation betweendiseased and healthy tissue. A boundary tool app could identifyanomalous areas of tissue using texture analysis techniques to assistthe surgeon in finding diseased areas and demarcating them. Such a toolcould potentially also be useful in helping a surgeon identify the bestlocations for obtaining biopsy samples.

In accordance with the preferred embodiment of the present invention,the medical software tools platform system 300 includes: an image streaminterface module 302; a user interface overlay module 304; medicalsoftware tools 310; a medical device interface module 306; and an imagestream processing system interface module 308. The medical softwaretools platform system 300 may be integrated, in whole or in part, into avideo display or an image stream processing system utilized in anoperating room. The image stream interface module 302 may receive animage stream acquired by a surgical camera or the like. Depending on theembodiment, the image stream may be received directly from the surgicalcamera, or may be provided by way of one or more components, such as animage stream processing system. The image stream received from the imagestream interface module 302 may vary in resolution, frame rate, format,and protocol according to the surgical camera or the image streamprocessing system providing the image stream.

The user interface overlay module 304 may provide a user interface tothe medical software tools platform system 300, which may include one ormore graphical user interface (GUI) elements presented over the imagestream received through the image stream interface module 302. For someembodiments, the user interface comprises a bottom toolbar configured tobe presented over the image stream, and configured to provide access tovarious medical software tools 310 available through the medicalsoftware tools platform system 300.

The medical software tools 300 may include one or more medical softwaretools, such as medically-oriented applications or widgets, which can beutilized with respect to the image stream being received through theimage stream interface module 302. The medical software tools 310platform includes but is not limited to: a medical device control module312; an image similarity search module 314; an image stream processingcontrol module 316; a measurement module 318; an image stream taggingand tracking module 320; a stereoscopic image stream module 322; anoptical signature module 324; a timer module 326; an image enhancementmodule 328; an embedded object tracking module 330; a grid overlaymodule 332; and a checklist module 334.

The medical device interface module 306 may facilitate communicationbetween the medical software tools platform system 300, one or more ofthe medical software tools 310, and one or more various medical devicesutilized in an operating room. The image stream processing systeminterface module 308 may facilitate communication between the medicalsoftware tools platform system 300 and an image stream processing systemutilized to process an image stream acquired by a surgical camera or thelike. Through the communication, the image stream processing systeminterface module 308 may transmit control data to an image streamprocessing system, or receive an image stream from a surgical camera asprocessed by the image stream processing system. The image streamprocessing system interface module 308 may include various datainterfaces, including wired or wireless network interfaces and serialcommunication interfaces.

FIG. 4 is a block diagram illustrating the measurement, opticalsignature module, timer and checklist modules within the medicalsoftware tools platform. In accordance with the preferred embodiment ofthe present invention, the medical software tools platform system 400may receive an image stream from an image stream processing systemthrough the image stream interface module 402. A specific area of theoverall image stream can be selected 410 and utilized within the userinterface overlay module 404, which may include one or more graphicaluser interface (GUI) elements presented over the image stream receivedthrough the image stream interface module 402. the user interfaceoverlay module 404 enables communication between the medical softwaretools platform system 400, and one or more of the medical software tools406, such as the measurement module 408, the optical signature module412, timer module 416, and checklist module 418.

The medical device interface module 424 may facilitate communicationbetween the medical software tools platform system 400, and one or moreof the medical software tools 406, such as the measurement module 408,optical signature module 412, timer module 416, and checklist module418. The measurement module 408 may facilitate measurement of one ormore anatomical structures or tissue presented in the content of animage stream received through the image stream interface module 402.Depending on the embodiment, the measurement module 408 may enable auser (e.g., surgeon) to select a region 410 in the image stream anddetermine a measurement based on the selected region. The measurementmay include linear measurements (e.g., width, height, length) andvolumetric measurements of an anatomical structure or tissue delineatedby the selected region.

The optical signature module 412 may facilitate the processing ofsignature data 414 such as optical sensor data, heart rate data and theoptical signature analysis engine. The timer module 416 may facilitatethe addition of one or more countdown timers, clocks, stop-watches,alarms, or the like, that can be added and displayed over the imagestream through the user interface provided by the user inter faceoverlay module 404. For example, the timer module may allow a user(e.g., surgeon) to add a countdown timer in association with a surgicalstep (e.g., clamping an artery). For example, a countdown timer may beassociated with a specific blood vessel that must be temporarily clampedduring surgery but must be opened within a small window of time. A usermay be able to select from a list of pre-defined countdown timers, whichmay have been pre-defined by the user. A clock when added may be used asa time bookmark during surgical procedures. The timer module 416 maycommunicate with an image stream processing system interface module 426utilized in an operating room to process an image stream acquired by animaging device 428.

The checklist module 418 may enable a user (e.g., surgeon) to add andmaintain a checklist in connection with a medical procedure 420. Forexample, the checklist module 418 may provide a list of checklist itemsfor a medical procedure. Each checklist item may indicate whether a stepof the medical procedure has been completed or has yet to be completed.The checklist module 418 may allow a user to present the checklist indifferent ways using the checklist module formatting settings 422. Forinstance, the checklist items may be organized and presented accordingto their procedural order, their importance, their relation to apatient's anatomy, their category, or their assigned individual (e.g.,checklist item is the nurse's responsibility versus the surgeon'sresponsibility). In another example, the checklist items may bepresented in using different visual structures, such as a tree structureor a scrolling list.

FIG. 5 is a block diagram illustrating the optical signature measurementmodule 512 within the medical software tools platform. In accordancewith the preferred embodiment of the present invention, an opticalsensor 502 located within an endoscopic camera lens 500 registers themomentary change in the spectral characteristics (or components)reflected from a tissue surface. This image data 504 is transmitted tothe medical image processing system 506, which can also receive datafrom a device such as a patient heart rate monitor 508. The medicalimage processing system 506 processes and transmits the image data 504from the optical sensor with data from the heart rate monitoring device508 to the user interface 510, whereby all sets of data are receivedthrough the optical signature measurement module 512, displaying therate of change 514 in the optical signature simultaneously with thepatient vitals data 516. This data is analyzed 518 in the module and theresults of any anomaly detection 520 are displayed to the user. Theslight changes in one of more of the spectral components, and the speedat which they change, in relation to a source stimulus (heartbeat,breath, external stimulus) indicates the arrival of blood, contrastagents, or oxygen absorption. Combinations of the components can be usedto characterize different types and states of disease and to identifythe margins of tumors and diseased areas. In addition to spectralcomponents, changes in temperature and its speed of change can bemeasured to similarly characterize surface and subsurface anomalies.

FIG. 6 is a rendering of the Surgeon's Desktop software toolset. Inaccordance with the preferred embodiment of the present invention, theSurgeons Desktop provides a framework for providing software apps orwidgets on a surgical display that can aid surgeons in performingvarious tasks during surgeries. The tools can assist a surgeon, forexample, with procedural requirements, such as checklists for specificsurgical steps; or ease mental fatigue, for example applying enhanced oraugmented imagery making it easier to see an area of interest; orprovide diagnostic support, such as identifying and highlightingsuspicious areas of tissue.

A new tool pertaining to tissue analysis is presented herein.Specifically, the tool measures change in color intensity and the rateat which it changes in response to: a) heart-beat pushing blood, b)breathing pushing oxygen, c) light from a light source. Furthermore,some light frequencies can cause tissue temperature to rise, which cancreate a change in pressure which can be measured which is called a“photoacoustic” response.

In addition, some of the Surgeon Desktop tools incorporatealgorithmic-based image processing to improve visibility duringendoscopic or laparoscopic procedures. For best results, the algorithmsneed to be adjusted for the particular subject matter and also theindividual preferences of the surgeon. Therefore, the specificmathematical operations within an individual algorithm and the specificcombinations of algorithms that are applied are typically determinedthrough a lengthy process of trial and error. Described herein is a newalgorithm developer tool that enables developers or advanced users torapidly explore the operation of various image processing algorithms andvarious combination of algorithms to obtain the best image clarity.

FIG. 7 is a rendering of the intensity height map tissue analysis tool.In accordance with the preferred embodiment of the present invention, amethod for detection of tumor margins by comparing previous readings,such as a spectral signature, was described in a prior filing. Thepresent invention identifies tumor margins in real time by comparingchanges and rates of change in a diseased area to adjacent and nearbysurrounding areas. Areas are defined by finding groups that have similarspectral signatures or rates of change. In certain embodiments, an areaof interest is first analyzed to identity those portions of the tissuethat respond to an influx of blood or body fluid corresponding to or insynchronization with the patient's heartbeat and only those portions areincluded in the comparison. In a preferred embodiment, the changes andrates of changes can be analyzed using artificial intelligence thatutilizes a database of historical samples.

The tissue analysis tool includes the following three sub-functions thatallow a surgeon to obtain different views to reveal greater detail ormonitor an area of interest. The three functions are height map, whichmeasure pixel intensity; color map, which applies different colorschemes; and margin guide, which provide a freeform drawing tool thatcan be used to highlight and geo-position an area interest. To use theheight map, the user selects the tool from the on-screen tool bar andsweeps an area of interest with the mouse. The selected area is enlargedand rendered as a “Picture-In-Picture” insert. The insert simulates a 3Dview by mapping the area's pixels onto an elevation grid using the pixelintensities to create a “height-map”. The user can experiment withdifferent views and degrees of detail by rotating the insert in 3D usinga mouse, adjusting for more or less detail with the window/levelsliders, and by scaling up/down with the vertical bar or mouse wheel.The “Pulse” button animates the pixel heights in relation to theintensity change resulting from the pulse of pumping blood into thelocal vascular network (“Pixels dance to the tune of the heartbeat”).The rise and fall height and rate of change in pixel intensitydemonstrate the different responses of diseased and healthy tissue.

FIG. 8 is a rendering of the color map tool. In accordance with thepreferred embodiment of the present invention, the Color Map toolpresents the surgeon with a choice of views of the tissue surface with achoice of color maps. The goal is to more clearly characterize themargins of diseased tissue. In one embodiment, the color map tool can beused to temporarily counteract or undo the visual effects of afluorescent contrast agent. In certain situations, a surgeon may prefermore natural coloring and contrast which may make it easier to seecertain details.

FIG. 9 is a rendering of the various color display tables for the colormap tool. In accordance with the preferred embodiment of the presentinvention, there are main menu settings that personalize the defaultchoices for each surgeon. The defaults include the presentation formatand color translation tables to display when the Color Map icon isselected. Mouse clicking a selection brings it to the primary displaywindow where it is subject to other tools for further analysis.

FIG. 10 is a rendering of the margin guide outline tool. In accordancewith the preferred embodiment of the present invention, the Margin Guidetool provides the surgeon with a freeform drawing tool to outline ananomalous area on the surface of tissue. The boundary line will stayanchored to its position as the underlying tissue moves. The anchoringpoints are identifiable features outside an enclosed boundary area. Inthe illustration, the “a,b,c” markers are unique identifiable tissuestructures that are used to geo-position the margin outlines. The goalis to provide a persistent guide during an excision of a mass. TheMargin Guide tool can also draw a suggested outline using the pixelintensities of surrounding tissue. A surgeon can then “fine tune” theshape as needed.

FIG. 11 is a rendering of the algorithm developer tool. In accordancewith the preferred embodiment of the present invention, a graphical toolenables advanced users to test and create new algorithms. Videoprocessing algorithms are a sequence of step-by-step mathematicaloperations that operate on an image flow in real time. The end resultexposes and highlights features in the image not discernable by thehuman eye. The development cycle for a new algorithm requires iterativetrial and error experiments and can be prohibitively time consuming. TheAlgorithm Developer tool enables an advanced user to flow the videothrough a sequenced series of mathematical functions (sub algorithms)selected from an extensible library of functions and view the result innear real time. Each new algorithm can be saved in the library andbecomes instantly available for use as a high-level video processingfunction, or saved in the library to serve as a sub-algorithm for newdevelopment.

The example illustrates building a 3D “Height-Map” of pixel intensitiesto show variations on the surface of live tissue. The video is flowedthrough a sequence of five processing nodes selected by the algorithmdeveloper. The output of each node becomes the input of the next node tocreate a new algorithmic function. The five-step sequence illustratedis: 1) “Video” node decodes recorded MPEG video and flows the frames toits output. The video node outputs a sequence of frames consisting of anarray of RGB pixels, 2) “Split” node converts RGB color to YCbCr toacquire the luminance “Y” channel to get the intensity of each pixel, 3)“Imgproc” Image Processing node applies a Gaussian convolution filter toeliminate noise and smooth the image, 4) “Resize” node scales the imageto a grid size suitable for mapping the elevation of pixel intensities,5) “LUT” Look Up Table provides a slider to select a pixel range toexpose more detail. The library of algorithmic functions includes a mixof both proprietary and open source modules from the public OpenCVarchive.

While various embodiments of the disclosed technology have beendescribed above, it should be understood that they have been presentedby way of example only, and not of limitation. Likewise, the variousdiagrams may depict an example architectural or other configuration forthe disclosed technology, which is done to aid in understanding thefeatures and functionality that may be included in the disclosedtechnology. The disclosed technology is not restricted to theillustrated example architectures or configurations, but the desiredfeatures may be implemented using a variety of alternative architecturesand configurations. Indeed, it will be apparent to one of skill in theart how alternative functional, logical or physical partitioning andconfigurations may be implemented to implement the desired features ofthe technology disclosed herein. Also, a multitude of differentconstituent module names other than those depicted herein may be appliedto the various partitions. Additionally, with regard to flow diagrams,operational descriptions and method claims, the order in which the stepsare presented herein shall not mandate that various embodiments beimplemented to perform the recited functionality in the same orderunless the context dictates otherwise.

Although the disclosed technology is described above in terms of variousexemplary embodiments and implementations, it should be understood thatthe various features, aspects and functionality described in one or moreof the individual embodiments are not limited in their applicability tothe particular embodiment with which they are described, but instead maybe applied, alone or in various combinations, to one or more of theother embodiments of the disclosed technology, whether or not suchembodiments are described and whether or not such features are presentedas being a part of a described embodiment. Thus, the breadth and scopeof the technology disclosed herein should not be limited by any of theabove-described exemplary embodiments.

Terms and phrases used in this document, and variations thereof, unlessotherwise expressly stated, should be construed as open ended as opposedto limiting. As examples of the foregoing: the term “including” shouldbe read as meaning “including, without limitation” or the like; the term“example” is used to provide exemplary instances of the item indiscussion, not an exhaustive or limiting list thereof; the terms “a” or“an” should be read as meaning “at least one,” “one or more” or thelike; and adjectives such as “conventional,” “traditional,” “normal,”“standard,” “known” and terms of similar meaning should not be construedas limiting the item described to a given time period or to an itemavailable as of a given time, but instead should be read to encompassconventional, traditional, normal, or standard technologies that may beavailable or known now or at any time in the future. Likewise, wherethis document refers to technologies that would be apparent or known toone of ordinary skill in the art, such technologies encompass thoseapparent or known to the skilled artisan now or at any time in thefuture.

The presence of broadening words and phrases such as “one or more,” “atleast,” “but not limited to” or other like phrases in some instancesshall not be read to mean that the narrower case is intended or requiredin instances where such broadening phrases may be absent. The use of theterm “module” does not imply that the components or functionalitydescribed or claimed as part of the module are all configured in acommon package. Indeed, any or all of the various components of amodule, whether control logic or other components, may be combined in asingle package or separately maintained and can further be distributedin multiple groupings or packages or across multiple locations.

Additionally, the various embodiments set forth herein are described interms of exemplary block diagrams, flow charts and other illustrations.As will become apparent to one of ordinary skill in the art afterreading this document, the illustrated embodiments and their variousalternatives may be implemented without confinement to the illustratedexamples. For example, block diagrams and their accompanying descriptionshould not be construed as mandating a particular architecture orconfiguration.

1-31. (canceled)
 32. A system for medical software tools, comprising: animage stream interface module configured to receive an image stream froma surgical camera; a user interface overlay module configured to providea user interface overlay adapted for presentation over the image stream;an optical sensor located corresponding with said surgical camera forregistering changes in spectral characteristics reflected from a tissuesurface under inspection; a medical software tools module configured toprovide a medical software tool through the user interface, the medicalsoftware tool being configured to perform an operation with respect tothe image stream and provide an output adapted to be presented over theimage stream; a medical image processing system for processing patientmedical data and corresponding said patient medical data with saidmomentary changes in spectral characteristics for generating opticalsignature data indicative of various patient conditions, wherein themedical software tool measures: a. changes in color intensity and b.rates at which said color intensities change in response to: heartbeatpushed blood, breathing pushed oxygen or light intensity or modulationfrom a light source; image markers used to delineate tissue areas ofinterest; annotation data input by said user indicative of quality ofobserved patient tissue; digital zoom feature activated by locationmarkers used to indicate an area wherein said image stream is processeddigitally for presentation of a zoomed in image for presentation to saiduser; and timers set by a user to facilitate the pace at which a medicalprocedure is performed.
 33. A system according to claim 32 wherein saidtimers correspond to a blood vessel clamped within a patient tofacilitate performing a medical procedure.
 34. A system according toclaim 32 wherein an optical signature module facilitates processing ofsaid patient optical signature data including heart rate data and imagedata.
 35. A system according to claim 34 wherein said optical signaturemodule generates optical signature data.
 36. A system according to claim35 wherein optical signature data includes timer data.
 37. A systemaccording to claim 32 wherein said timer data may include countdown datato guide a user for performing a medical procedure.
 38. A systemaccording to claim 32 where in a height intensity map is used to analyzetissue.
 39. A system according to claim 32 wherein a color map isgenerated in response to various said spectral components generated. 40.A system according to claim 32 wherein a user defined checklist iscombined with said patient optical signature data so that a user isreminded not to miss medical procedure steps.
 41. A system according toclaim 32 wherein said patient optical signature data is combined withmargin guide data so that a user may define and utilize a margin ofclear tissue surrounding a tissue location of interest to said user. 42.A system according to claim 32 wherein said patient medical dataincludes images from a medical procedure and said images are securelystored for later reference.
 43. A system according to claim 41 whereinsaid securely stored images are compared with later generated imagesresulting from said identical patient.
 44. A system according to claim41 wherein said securely stored images are compared with imagesresulting from other patients for comparison of corresponding tissueimages between different patients.
 45. A system according to claim 43wherein said image comparisons may include a multitude of patient tissueimage comparisons to form a model of what is considered healthy tissue.46. A system according to claim 32 wherein said timers are controlled inpart by optical signature values related said patient tissue condition.